IAN Research Findings: Animal-Assisted Therapies
The Interactive Autism Network (IAN), the largest online autism research project in the United States, has collected information about use of treatments from thousands of families of children with autism spectrum disorders (ASDs). How many of them have reported the use of animal-assisted therapies, like therapeutic horseback riding, pet or canine therapy, or dolphin therapy? What did they share about their experiences?
Please Note: These Findings Are Preliminary
The analyses presented here by the Interactive Autism Network are preliminary. They are based on information submitted via the Internet by parents of children with autism spectrum disorders (ASD) from the United States who choose to participate. They may not generalize to the larger population of parents of children with ASD. The data have not been peer-reviewed -- that is, undergone evaluation by researchers expert in a particular field -- or been submitted for publication. IAN views participating families as research partners, and shares such preliminary information to thank them and demonstrate the importance of their ongoing involvement.
Animals: Pets, Friends, Guardians...and Therapists
From the time early canines switched their allegiance from pack to man, domestic animals have served humans and, in some cases, formed emotional bonds with them. Everyone is familiar with tales of animals who comfort, guard, or protect people, sometimes in extraordinary ways. Headlines like Hero Dog Saves Boy, 11, From Cougar Attack 1 remind us of this on a regular basis.
In addition to their roles as companions and helpers, animals have also been thought to help the physically or mentally ill or disabled to cope or heal. Even before interest in health-promoting effects of human-animal interaction grew in the 1960s, animals had been used for therapeutic purposes. Nurses Sarah Brodie and Francis Biley note:
In the 9th century, family care involving animals was given to handicapped people in Gheel, Belgium. The York Retreat, an asylum, replaced restraint with love, kindness, understanding, trust and animals during the 1790s. Animals were used in a home for epileptics in Germany in the 1800s and in a World War II convalescent hospital. 2
Over the last few decades there has been increasing interest in, as well as research on, the health benefits of pet ownership, animal visitation (such as in a hospital or nursing home setting), and animal-assisted therapy (AAT). 3,4,5,6,7 Investigations of the potential benefits have focused on a variety of groups, from Alzheimer's patients 8 to children recovering from surgery. 9 More recently, some researchers have turned their attention to animal-assisted therapy for children on the autism spectrum, 10,11,12,13 as well as the use of service dogs with these children.14
For more information on AAT research, see our companion article Dogs, Horses, and ASD: What Are Animal-Assisted Therapies?
IAN Families: Use of Animal-Assisted Therapies
Of the more than 8,000 families participating in the IAN Research project who have reported on treatments, 514 (or about 6%) have reported using an animal-assisted therapy or AAT. Some were trying more than one, so that information about 568 AATs was submitted. Of all AATs, therapeutic horseback riding, also known as equine therapy or hippotherapy, was most frequently used, with 349 children taking part. In addition, 168 families were using "animal" or "pet" therapy. Only 51 were using canine therapy or a service dog, although it is likely some "dog therapy" families listed their treatment under "animal" or "pet" therapy. No one reported using dolphin therapy. (See Figure 1.)
Families shared experiences involving all kinds of child-animal bonds and interactions. For example, some children were involved in programs where a dog was made available to children in a school or therapeutic setting. "Our son, Jeff, is able to work with therapy dogs twice a week at school and also is involved in an animal therapy program one afternoon per week," his mother told us. "He takes great pride in being able to take care of the animals and is very good at following directions on what to do. It has given him some independence. He has been working with the dogs for about 6 years."
Some families had brought animals into their homes and their lives, hoping regular interaction with a loving pet would help their child. Dogs were mentioned most often, but so were snakes, rabbits, and cats. One mother described her son's bond with the family felines, and his empathy for them: "Mark cares for the kitties and worries about them. He loves to interact with them and he will sing to them to help them ‘feel safe.' He gives us glimpses into what he is feeling by telling us when he thinks the kitties are scared or nervous."
A number of families were enthusiastic about equine therapy, saying it had been a wonderful experience for their child on the autism spectrum. "This is the therapy where I have seen the most improvement with Suzie," one mother declared. "She seems to enjoy horseback riding because it not only feels good in a sensory way, but it creates a sense of competency and confidence. In the past couple of months, she has graduated to steering the horse all by herself and trotting (without complaint, which is new to her) in a 2 point stance. She was all smiles during her recent horseback riding sessions."
There were stories of disappointment, as well. Some families found their child was indifferent to an animal they tried to introduce, and that the hoped-for bond didn't form. One mother said, "At a very young age Adam had a fascination with water. We had 3 ponds at the time. It only took one time for him to take off to a pond to throw a rock into it and I had to run to all three ponds to find him... I decided to purchase a Labrador and train it myself to find all children when asked. The dog was very successful at this job but because of the lack of response from my child she would rather not find him. She was very willing to find any other child but the child I wanted her to find."
"My son was miserable with the horseback riding program," a mother who had tried equine therapy said. "He was bored, frustrated, and had no interest in connecting with the horse."
A fairly small number of families reported having a service dog. These specially trained animals were in the home as a constant presence, like a pet, but also were able to perform functions no untrained dog could. Similar to families who participated in a Canadian study on service dogs and children with ASD,14 IAN families described how their service dogs helped prevent children from bolting, both when out in public and at night. They also explained how the dog's presence often smoothed the way socially, giving people an excuse to approach and interact and also giving them some idea that the child might have some issues. (Parents of children with ASD often comment that people give critical looks, thinking their children "bratty" rather than disabled because they appear so physically normal.)
One grateful mother explained the many ways she felt their service dog had helped her son: "When we have the dog, and Sean has a tether, we do not experience stimming or self-injurious behavior. Sean is quite excited to take his dog to the store or the movies. He naturally responds to questions about his dog and it also helps him with eye contact and restricts his repetitive body movements... At home when Sean is experiencing difficulties, the dog applies deep pressure by lying on or leaning against Sean."
What symptoms or challenges associated with a child's autism spectrum disorder were families hoping to address when they introduced an animal into his or her life?
Based on information from the nearly 400 parents who shared what they viewed as "targeted symptoms," increases in social and communication ability were most often hoped for. (See Figure 2.) This makes sense when you consider that, compared to humans, animals may provide a simpler, nonverbal form of social give-and-take.
For example, responding to a dog bringing you a ball or barking to be let out involves reading another creature's intent and coming up with an appropriate response, but requires much less social know-how than, say, behaving as expected at a birthday party. Likewise, learning how to exert the correct amount of pressure while petting a dog requires caring about and noticing what this other creature, outside yourself, would like, while telling a horse to stop or go requires communication, whether verbal ("Whoa!") or physical (pulling on the reins).
In addition to social and communication benefits, families also mentioned relief of symptoms we might not have expected. "I purchased our dog a month after my son's diagnosis," said one father. "When my son would start to stim or head bang, the dog would jump up and demand attention and my son's behavior would be interrupted." Other parents related how a child who had been afraid of animals was able to get over that fear and learn to enjoy them.
Those using equine therapy mentioned additional therapeutic goals, both physical ones (like improvement in gross motor skills, gait, or balance) and emotional ones (like increased confidence or self-esteem). "Sam has done better than I ever anticipated learning to ride a horse," one mother told us. "He is happy, focused, using great posture, balance, and muscle control. It has improved his confidence, and given him more respect for animals."
Some parents said they hadn't really seen any gains made, but felt their child's experience with an animal was valuable in its own right. "Though I don't see any noticeable physical/mental improvement, my son loves the interaction with the animals on the farm as well as riding the horse; therefore, we will continue the horseback riding," one father said.
Costs and Burdens
Only 12% of families told us insurance had covered some or all of their animal-assisted therapy. (See Figure 3.) On the other hand, 25% reported they had obtained the therapy for free. How this was possible became clear from parents' comments.
In some cases, visits from therapy dogs were included as part of a school program, or a service dog was provided by a charity. Horseback riding, which could get expensive, was often paid for or subsidized by corporate sponsorships or organizations like the United Way. Some stables let families contribute their time and energy instead of paying cash: "The stable allows any special needs child to participate for free. We pay with donations of our time, helping around the farm. We bring apples and carrots for the horses, clean stalls and tack, build fences, etc."
Most families who did pay for AAT spent less than $100 per month with the exception of those using equine therapy. Nearly 50% of families who were self-paying for that spent $101-$500 per month.
When asked about the burden they felt would be associated with the treatment, 64% said they expected AAT to come with "no" or "minimal" burden. Horseback riding did present some obstacles for families in addition to any cost, however, including time-consuming drives to get to a distant stable and lack of transportation altogether for families without a car.
When asked about treatment risk, 79% of parents said they believed AAT posed no or minimal risk to their child. Their hopes for effectiveness were modest, with 81% hoping for "minimal" or "moderate" improvement. Most were pleased with their experience so far. Fully 83% reported their child had improved on the therapy. (See Figure 4.)
At this point there is little research-based evidence that AATs lead to specific gains by children with ASD, but interest in the topic is growing in parallel with the field of AAT itself. 7 Researchers are beginning to look at therapeutic visits with animals, 12 equine therapy, 10,15 and families' experiences with service dogs, 14 among other things.
One challenge in getting such research accomplished will be to somehow take into account intangibles. You can more easily measure IQ or language ability than concepts like "empathy" or "self-confidence," yet it is these things that many parents talk about when expressing enthusiasm for AATs.
- The Happy Hannah Dance
A post about the bond between a dog and girl with ASD on the Autism Speaks blog by IAN's Assistant Editor, Teresa Foden.
- Dogs, Horses, and ASD: What Are Animal-Assisted Therapies?
Learn about animal-assisted therapies and the use of service dogs by children on the autism spectrum. What challenges are these interventions used to overcome, and what research has been done to tell us whether they are effective?
IAN provides these links as a service to the reader, but has no firsthand knowledge of the organizations listed and cannot vouch for them.
- 4 Paws for Ability claims to be the largest autism service dog organization in the United States, and to have been the "first agency to begin placing skilled autism service dogs" with families.
- The Delta Society's online National Service Animal Resource Center provides info and resources for individuals with disabilities and families considering getting a service animal.
- The Assistance Dog United Campaign is an organization that provides financial help to individuals who need a service dog but have difficulty raising the money for one. It has a list of member service providers.
- Therapy Dogs International is a volunteer organization that tests, evaluates, and registers therapy dogs and their handlers so they can visit nursing homes, hospitals, and other institutions.
- The American Hippotherapy Association promotes the use of horses as a treatment in physical, occupational, and speech-language therapy sessions.
- Celizic, M. (2010, January 5). Hero dog saves boy, 11, from cougar attack. TODAY.com. Retrieved March 7, 2011.
- Brodie, S. J., & Biley, F. C. (1999). An exploration of the potential benefits of pet-facilitated therapy. Journal of Clinical Nursing, 8(4), 329-337. View Abstract
- DeCourcey, M., Russell, A. C., & Keister, K. J. (2010). Animal-assisted therapy: Evaluation and implementation of a complementary therapy to improve the psychological and physiological health of critically ill patients. Dimensions of Critical Care Nursing: DCCN, 29(5), 211-214. View Abstract
- Walsh, F. (2009). Human-animal bonds I: The relational significance of companion animals. Family Process, 48(4), 462-480. View Abstract
- Odendaal, J. S. (2000). Animal-assisted therapy -- magic or medicine? Journal of Psychosomatic Research, 49(4), 275-280. View Abstract
- Palley, L. S., O'Rourke, P. P., & Niemi, S. M. (2010). Mainstreaming animal-assisted therapy. ILAR Journal/National Research Council, Institute of Laboratory Animal Resources, 51(3), 199-207.
- Fine, A. H. (Ed.). (2006). Animal-assisted therapy: Theoretical foundations and guidelines for practice (2nd ed.). San Diego: Academic Press.
- McCabe, B. W., Baun, M. M., Speich, D., & Agrawal, S. (2002). Resident dog in the Alzheimer's special care unit. Western Journal of Nursing Research, 24(6), 684-696. View Abstract
- Sobo, E. J., Eng, B., & Kassity-Krich, N. (2006). Canine visitation (pet) therapy: Pilot data on decreases in child pain perception. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses' Association, 24(1), 51-57. View Abstract
- Keino, H., Funahashi, A., Keino, H., Miwa, C., Hosokawa, M., Hayashi, Y., et al. (2009). Psycho-educational horseback riding to facilitate communication ability of children with pervasive developmental disorders. Journal of Equine Science, 20(4), 79-88.
- Martin, F., & Farnum, J. (2002). Animal-assisted therapy for children with pervasive developmental disorders. Western Journal of Nursing Research, 24(6), 657-670. View Abstract
- Redefer, L. A., & Goodman, J. F. (1989). Brief report: Pet-facilitated therapy with autistic children. Journal of Autism and Developmental Disorders, 19(3), 461-467. View Abstract
- Solomon, O. (2010). What a dog can do: Children with autism and therapy dogs in social interaction. Journal of the Society for Psychological Anthropology, 38(1), 143-166.
- Burrows, K. E., Adams, C. L., & Spiers, J. (2008). Sentinels of safety: Service dogs ensure safety and enhance freedom and well-being for families with autistic children. Qualitative Health Research, 18(12), 1642-1649. View Abstract
- Bass, M. M., Duchowny, C. A., & Llabre, M. M. (2009). The effect of therapeutic horseback riding on social functioning in children with autism. Journal of Autism and Developmental Disorders, 39(9), 1261-1267. View Abstract